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Public Health

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Overview

Disasters change the landscape in numerous ways, and only a portion of the changes are immediately evident. That’s especially so when it comes to public health. Public health encompasses efforts to protect and improve the health of communities as a whole, including the promotion of healthy lifestyles, research into the prevention of injury and disease, and education. The healthier the community and the more resources it has before disaster strikes, the greater resilience that community will show.

In October 2010, ten months after the devastating earthquake rocked Haiti, a cholera outbreak was identified; it went on to sicken 470,000 Haitians and nearly 7,000 died. Cholera typically spreads in places with deficient water treatment, inadequate hygiene, and poor waste management, and the event only magnified a precarious situation. Some might believe the outbreak was a direct result of the earthquake, but others consider the timing more coincidental. It’s estimated that just half of the nation’s population had access to clean drinking water before the earthquake occurred, and less than one quarter had sufficient access to sanitation, like latrines.

In 2005, when Hurricane Katrina hit New Orleans, La., the complication was not cholera. But prior public health concerns played a role here, too. Before the storm, a quarter of the population lived below poverty levels and one in five was uninsured, resulting in an overwhelming load on an already overburdened health delivery system. And almost all of the deaths were among the already vulnerable elderly and/or African American populations.

The impact a disaster has on an affected population’s health is far from predictable. A variety of factors influence the spread of disease and other health-related issues following an event, and many can be mitigated with thoughtful planning.

Disaster preparedness efforts that consider, for example, health facility capabilities, reproductive health, mental health, and water, sanitation, and hygiene greatly lessen the toll of sickness on compromised populations. The field is rife with opportunities for further study, investment, and improvement across the disaster life cycle, from risk reduction through long-term recovery, including the preparedness and resources of affected and at-risk populations.

Key Facts

Disaster-related health needs typically do not show up immediately. Some health concerns will not appear until much later, especially in terms of mental health. Consider the challenges of survival after livelihoods have been lost, such as the loss of livestock, which represents years of accumulated family wealth. Also of concern: ongoing issues following the death of the head of a household.

Damage to health care facilities—and diagnostic equipment—can have long-reaching consequences. So, too, can damage to infrastructure such as roads and bridges, keeping people from being able to connect to services they need. In addition, losses that affect the personal lives of healthcare workers also affect the ability of health facilities to provide services.

Water, sanitation, and hygiene conditions before and after a disaster can greatly affect the level of impact on a community’s health. Drinking water supply and waste management are especially important factors in controlling disease, as is the management of toxic substances released by the disaster.

Often, post-disaster outbreaks of disease are associated with population displacement. Widespread disasters such as hurricanes, famine, or floods can result in large groups of people being evacuated. But disease tends to spread in overcrowded areas without proper access to healthcare services. In resource-poor areas, already decreased nutritional status and lack of vaccinations can contribute to the problem. Sometimes this can mean outbreaks of diarrhea, but other times, it could be respiratory infections or conjunctivitis with so many in close quarters.

Disasters can exacerbate reproductive health needs. Along with damage to facilities, equipment, medications, and other infrastructure, access to services could decrease. Other concerns can take higher priority. In addition, periods of high stress, overcrowding in temporary relief situations, and challenges related to hygiene could increase the chance of sexually transmitted diseases and gender-based violence. And yet, pregnancies and deliveries continue, even with diminished facilities and a decrease in the number of skilled healthcare workers.

How You Can Help

Support local efforts to bolster critical services and build community resilience. On a larger scale, strengthen water treatment and sewer facilities to better withstand disasters. On a smaller but equally as important scale, fund efforts to improve healthcare equipment, support hygiene programs, and ensure plans for mental health access are in place.

Fund risk reduction activities such as vulnerability assessments for potentially disaster-prone areas and impact mitigation. Fund the creation of rapid needs assessments to collect reliable data about the needs of affected communities after disasters occur. In addition, identify marginalized and vulnerable populations that suffer the most in disasters, assessing their unique needs. In terms of mitigating impact, include the creation of public health communications that are reliable, consistent, and culturally relevant.

Fund training for healthcare providers to identify and strengthen the most vulnerable populations. Recognize that different populations may be more vulnerable to different disasters.

Support programs that assist care givers in disaster-affected areas. They may be coping with their own grief while assisting others.

Fund the transfer to electronic medical records in higher-income areas. These are less easily “lost” following a disaster.

Support research into the ongoing effects of disasters on populations, as well as effective ways to build coping capacities among individuals and communities. Also worth study: methods of promoting early recovery and mitigation of the impact of future disasters.